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Saturday, 14 January 2017

Claim Scrubber Optimizes Radiation Therapy Claims Reimbursement

Radiation oncology billing is especially difficult because of the planning and staging processes that occur prior to treatment. On a bad day a coder can create future problems that are difficult to remedy. Fortunately, Iridium Suite offers a safety net to help you avoid the pitfalls of improper coding.

A claim scrubber is a built-in editor, like spell check, except it is automatic. Iridium Suite medical system software features a scrubber that has many capabilities, so a biller can be confident that many billing violations will be caught by the claim scrubber before the claim is generated.

The claim scrubber is present and active in the background during billing work, whether during the importing of charges from outside systems (such as record and verify systems or EMR's/EHR's) or while manually coding charges.

Here are a few examples of the functions of Iridium Suite’s claim scrubber:

The claim scrubber offers suggestions for converting old, outdated codes to newer ones, or requests permission to add a modifier to an E & M (evaluation and management) code that conflicts with other codes billed the same day, such as 99204 with 77263.

The biller has the option of re-evaluating the code and overriding the warning edit or allowing the scrubber to change it.

The claim scrubber sets a warning status on service lines that may be correctly coded but which conflict with other services according to NCCI (National Correct Coding Initiative) edits.

A pop-up window shows the NCCI conflict and rule regarding the services billed. The biller has the option of choosing to override the warning status or the biller can change the date on the service that is being billed to avoid the conflict. The service line may also be deleted and a more appropriate service can be coded.

PQRI/PQRS is a potential ‘miss’ on any patient having Medicare or Medicaid. If a medical practice activates the PQRS scrubber, then the scrubber is configured to automatically request that the physician sets up PQRS measures for each patient whose treatment qualifies for PQRI.

The claim scrubber also recognizes which billing codes are potential PQRS denominators and automatically suggests the PQRS numerator codes that should be added to the claim. The biller simply accepts these suggestions and the claim scrubber automatically adds the proper PQRS charge codes to the claim.

In addition, the Iridium Suite claim scrubber makes every radiation oncology biller’s life better by automatically adding up the patient’s daily treatments and applying the management code 77427 with its corresponding dates. This feature is a fantastic time saver and ensures that this often-forgotten code is billed out properly.

Iridium Suite’s claim scrubber is only one of the many ideally designed tools integral for the best radiation oncology medical practice billing software available. It saves time and money and prevents potential errors that delay receipt of your claim reimbursement.

Now What Was I Supposed To Do?

Recent news stories have relayed studies that proclaim the numerous and varied health benefits of drinking coffee. About 83% of adults in the US drink coffee. Many drink it for that “boost of energy” provided by the caffeine. An average size cup in 9 ounces contains about 200 mg of that key ingredient. According to one such story that caffeine may do more than perk you up; it may also improve your memory.

caffeine improves memory

Since I do not work for any coffee consortium or own stock in some coffee shop chain store, my intent is not to have you drink more coffee, but instead to think about memory. More specifically, what you have to remember to do when you are performing your daily medical billing tasks.

In no particular order:

Check charge slips received or codes captured against the appointment schedule

Verify documentation has been completed for the service provided

Add modifiers as required by CCI edits

Verify appropriate authorizations are in place and attached to charges accordingly

Collect co-pays at time of service

Generate daily, monthly, quarterly, etc. reports

Import and adjudicate ERA files

Review EOBs for service denials

Enter in charges from charge slips or from data in the EMR

And the list goes on and on as you know.

So, what can help you to get all these things done and ease up the pressure on your memory? The advanced features of Iridium Suite Practice Management Software can. Listed below are some of the key functions of this medical billing system that will keep you from needing an IV infusion of that aromatic brew.

The Connectivity Clearinghouse enables connections to multiple EHR systems. You can connect to your EHR as often as your office work flow dictates. With accurate and complete data entry in your EHR, you are able to bring in all the necessary information to bill and file your patient claims.

The Report Center Module of the billing software allows the user to format, save and schedule reports that are automatically sent to your email. Reports such as “Chargeless Accounts” and “Scheduler Discrepancy Report” can be auto-created daily to use as a check list against missing charges.

The EDI functions found in billing system provides access to Real Time Eligibility and electronic claim submittals for hundreds of payers. It will also automatically adjudicate ERAs received from the ACH with little to no user interaction.

The Accounts Receivables module of Iridium Suite enables a “paperless” review system for both payers and patients. This eliminates that unsightly desktop mess and provides the manager the ability to “electronically assign” selected open ARs to office staff for appropriate follow up.

A built-in Claim Scrubber automatically checks against current CCI edits as well as providing the user with customizable, practice specific rules that can be applied as defaults to all payers or made payer specific.

The To-Do reminder function found in the practice management software, gives each user the ability to create an electronic “sticky note” for themselves or other users. This function is extremely useful for staff in need of collecting money or insurance information from incoming patients.